KR20190021473A - Surgery for small incision underestimation - Google Patents

Abstract

It is an object of the present invention to provide an ophthalmologic apparatus capable of flexibly operating and securing an operation field depending on a surgical site or a surgical situation, So as to facilitate the operation of the apparatus.
(1), which is a thin plate of a tin agent having a purity of 99.9% or more, and a thin rectangular oblong body (2) in an unfolded state, . It can be inserted into the body from the small incision window in the form of a rectangle or in a compact form and can be easily carried to the opening of the body by the surgical instrument. It is possible to hold the opening portion in an opened state so as to secure an operative field of view by placing the opening portion of the body in a form bent and deformed into a necessary shape by a surgical instrument. Since the base body 2 is a tin agent having a purity of 99.9% or more, the base body 2 can be easily bend-deformed to a desired shape by using a surgical instrument because of its high flexibility.

Description

Surgery for small incision underestimation

The present invention relates to an opening device for inserting a small incision in a chest or abdomen in a small-incision under-revision surgery and keeping the opening part of the incision in the incised state open so as to secure an operation field.

Small incision subcutaneous surgery is performed using a surgical instrument such as a forceps or an electric scalpel while inserting several small incisions in the chest or abdomen and viewing the inside of the body cavity by thoracoscopic or laparoscopic procedures. Therefore, the incidence of surgical treatment is greatly reduced because the post-operative pain is very small and the scar is not noticeable compared with the open thoracotomy or open surgery for performing incision, and at the same time, the patient's quality of life Quality of Life (QOL) can be greatly improved.

The securing of the surgical field in the operation under the small incision subscapes can be accomplished by inserting a surgical instrument having a hook at its tip end from the small incision window and manually pulling the surgical assistant in a state in which the distal end of the surgical instrument is fixed to the open mouth of the body (Hereinafter referred to as " opening with hook type hook ").

In addition to the use of pull-type hooks, a plate-shaped body having elasticity is used as an opener for securing an operative field of view, although it is not used for small-incision subcutaneous surgery (for example, see FIGS. 1 to 5 of Patent Document 1, 4 of Patent Document 2).

Patent Document 1 discloses a method of inserting a small opening into a can opening in a state that the whole is compacted into a small diameter cylinder by using an opening device formed by molding a star end and a terminal end in a slidable state into a cylindrical shape with a large outer diameter, To expand the opening area.

Patent Document 2 discloses a method of forming a shape memory alloy having a shape memory property at a living body temperature (about 37 ° C) by molding the shape memory alloy into a plate shape, and using a reformer having a shape of a large- And inserted into the dog window portion so as to enlarge the opening portion by the shape memory effect generated by the body temperature of the patient, thereby widening the opening portion.

Patent Document 1: Japanese Patent Application Laid-Open No. 2007-082674 Patent Document 2: Japanese Patent Application Laid-Open No. 2006-304819

It is difficult to secure an operative field of view by the practitioner (of the home doctor), and also to secure the visual field of view according to the surgical site and the surgical situation, The change can not be performed flexibly.

In addition, in the case of opening with the pull type hook, the burden of the operation assistant is large, and the operation cost is increased because the labor cost of the operation assistant is increased.

In addition, when the surgical assistant is not pulled, a mechanism for holding the pulling-type hooks outside the body is required, which hinders the operation in the small incision surgery.

In the case of using the opener such as Patent Literature 1 or 2, for example, in the operation under the small incision, the plate-shaped body is compacted into small pieces to form a small-sized opener (for example, the left side of FIG. 1 of Patent Document 1, (See the lower side of Fig. 4) is inserted into the body from the small incision window and released, the diameter of the cylinder becomes enlarged due to the elastic restoring force or the shape memory property (for example, (See the upper drawing of Fig. 4 of Patent Document 2), it is difficult to move and arrange it to the opening portion of the body.

In addition, even if an opening section in the body can be maintained in an open state to secure an operative field of view by using an opening device such as Patent Document 1 or 2, since the opening state is a cylindrical shape with a large outer diameter in use, Which is accompanied by a great difficulty.

SUMMARY OF THE INVENTION Accordingly, the present invention has been made in view of the above circumstances, and it is an object of the present invention to provide a surgeon's eye view which can be easily secured, The present invention provides an incision catheter for operation under a small incision which is easy to move to a necessary position of a surgical site or to be taken out postoperatively.

In order to solve the above-mentioned problems, according to the present invention,

In the operation under the small incision, the incision in the incision is maintained in the open state to secure the surgical field.

A thin plate of a tin agent having a purity of 99.9% or more, and an elongated rectangular substrate in an unfolded state,

The gas is inserted into the body from a small incision window in a form in which the gas is expanded in a rectangular shape or in a form in which the gas is compacted into small pieces,

The surgical instrument according to claim 1, wherein the surgical instrument is used to perform a bending deformation of the gas by the surgical instrument so as to be placed on the open mouth.

In order to solve the above-mentioned problem, the reformer for small-incision under-examination according to the present invention is characterized in that, in the sub-incision sub-op surgery, the incision is made in the open incision, as,

A thin plate of a tin agent having a purity of 99.9% or more, comprising an elongated oblong gas in an unfolded state,

And fixing means for fixing the distal end of the surgical claw to the base,

Wherein the fixing means is inserted into the body from the small incision window in a state in which the base body is formed into a rectangular shape while the distal end portion of the surgical claw is fixed to the base body with the surgical claws,

The gas is transported to the opening part of the body by the surgical hook, and the gas is bent and deformed to a necessary shape by the surgical instrument used for the small incision undergrowth operation, so that the gas is used in the state of being placed on the opening part.

In this embodiment, the outer shape of the base is preferably 1 to 5 cm in width, 3 to 20 cm in length, and 0.5 to 2 mm in thickness (claim 3).

According to the construction of the opener for the operation under the small incision, the gas of the opener is a thin plate of a tin agent having a purity of 99.9% or more, and since it is an elongated rectangular shape in an expanded state, It can be easily inserted into the body through the small incision window inserted into the abdomen and can be easily transported to the opening portion of the body incised during the operation by the surgical instrument used for the surgery under the small incision or under the surgical grip fixed to the gas.

In addition, since the gas of the canopy is a tin agent having a purity of 99.9% or more, the gas can be easily bend-deformed to a desired shape by using the above-described surgical instrument because of its high flexibility.

Therefore, the opening portion can be kept open so as to secure an operative visual field by being bent and deformed into a required shape and being put on the opening portion of the body.

In order to maintain the opening portion in an opened state, the width of the gas of the opening device in the shape expanded in a rectangular shape corresponding to the size required for the use portion is set to 1 to 5 cm, 20 cm, and then the thickness of the base is selected in the range of 0.5 to 2 mm so as to secure the required bending rigidity at the site of use.

In addition, since the gas of the opener can be easily deformed, it is easy to secure the surgical field of view of the practitioner (of the doctors), and the securing and changing of the surgical field depending on the surgical site and the surgical situation can be performed flexibly have.

In addition, by operating the opening device by a practitioner, the burden of the operation assistant such as the opening with the pull-type hook can be eliminated, and the operation cost can be reduced by the reduction of the labor cost.

In addition, since the gas of the opener is a tin agent having a purity of 99.9% or more, it can be easily returned to the shape of a rectangular shape or the shape of a small aggregate by using the above-described surgical instrument after bending- It can be easily taken out of the body.

Particularly, in the configuration in which the fixing means is provided and the distal end portion of the surgical claw is fixed to the base of the opening cage (Claim 2), in the state of fixing the distal end portion of the surgical claw to the base body, It is possible to easily and surely carry the catheter to the catheter opening in the incision during the operation and to easily and reliably take out the catheter from the catheter to the outside of the catheter after the operation. In addition, since the gas of the canine is fixed to the distal end of the surgical claw, it is possible to reliably prevent the canker from being lost in the canine.

It is a further preferred embodiment that the bending portion bent in a loop shape around an axis parallel to the short direction of the base is provided on the end portion of the base in the longitudinal direction of the base in the form of extending the base in a rectangular shape ).

The tubular body may have a through-hole parallel to the short-side direction of the base at a longitudinal end of the base in a rectangular shape.

According to such a configuration of the opener for operation under the small incision, by holding the appropriate portion of the bending portion or the tubular body with the end effector of the jaw or the like of the surgical instrument used for the operation under the small incision, The work of deforming the gas of the canal into a necessary shape becomes easy.

It is still more preferable that the anti-slip portion is provided on one or both sides of both surfaces of the base (Claim 6).

According to the construction of the opener for the operation under the small incision, since the opening portion is not easily dropped from the opening portion of the body by the non-slip convex portion on the surface of the base of the opening portion, the operation portion is suddenly moved, The surgical instrument and the like abruptly come into contact with the non-affected part to avoid damage, and the operation can be performed efficiently while maintaining the surgical field.

Further, it is still more preferable that the spiral convex portion is provided on the cylindrical surface of the base body deformed into a cylindrical shape (Claim 7).

According to the configuration of the opener for the operation under the small incision, when the gas of the opener is deformed into a cylindrical shape, when the spiral convex portion formed on the cylindrical surface is a right-handed screw, When the helical convex portion formed on the cylindrical surface is a left-handed type, it rotates in the counterclockwise direction, and when it is rotated in the clockwise direction, it moves backward.

Therefore, it is easy to move the opening device in the entry direction or the backward direction with respect to the opening portion of the body.

In addition, since the opening portion is difficult to fall from the opening portion due to the spiral convex portion formed on the cylindrical surface, the opening portion suddenly moves to suddenly come into contact with the portion that is not the affected portion, It is possible to efficiently perform the operation while keeping the surgical field clear.

It is still more preferable that the through-hole in the thickness direction is provided at an end portion in the longitudinal direction of the base in a form in which the base is extended in a rectangular shape (Claim 8).

According to the configuration of the opener for the operation under the small incision, the one end is fixed by passing the thread through the passage hole provided in the end portion in the longitudinal direction of the base, and the other end of the thread is inserted It is possible to reliably prevent the lancet from being lost in the body by pulling out the lancet from the small incision window.

In addition, when the gas is likely to be twisted in the opening portion of the body, the gas can be fixed by fixing it to a nearby tissue through a thread passing through the passage hole.

As described above, according to the catheter for surgery under the small incision under the present invention, mainly the following effects (1) to (5) are exhibited.

(1) In the form of a rectangle or a small cone, it can be inserted into the body from a small incision in the thoracic or abdomen, and can be inserted into the body by a surgical instrument used for under- It can be easily carried to the dog window portion in the incised body.

(2) It is possible to hold the opening portion in an opened state so as to secure an operative visual field by being bent and deformed into a necessary shape and being put on a can opening portion in the body.

(3) It is easy to secure the surgical field of view of the practitioner (of the home doctor), and it is possible flexibly to secure and change the surgical field depending on the surgical site or the surgical situation.

(4) By operating the opening-and-closing mechanism by a practitioner, the burden of the operation assistant such as the opening with the pull-type hook can be eliminated, and the operation cost can be reduced by the reduction of labor costs.

(5) After use, it can be returned to the shape of a rectangle or the shape of a small cluster, and can be easily taken out from the small incision window to the outside of the body.

BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1 is a perspective view showing a rectilinear opening device for small incision and under-surgery according to an embodiment of the present invention; Fig.
2A is a front view of the same.
2B is a bottom view of the same.
FIG. 3A is a bottom view showing a modified example in which the bent portion at the end in the longitudinal direction of the base body is changed into a cylindrical body which is different from the base body.
Fig. 3B is a bottom view of an enlarged vertical section of the main part of the modification shown in Fig. 3A.
4 is a perspective view showing a form in which a base body is deformed into a cylindrical shape as an example of a necessary shape of a can opener.
5A is a perspective view showing a modified example of the convex portion formed on the cylindrical surface, and shows an example in which the convex portion is three rows in the width direction.
Fig. 5B is a perspective view showing a modified example of the convex portion formed on the cylindrical surface, and shows an example in which the convex portion is four rows in the width direction.
6 is a longitudinal sectional bottom view showing an example in which convex portions are formed on both surfaces of the base body.
7 is a perspective view showing a passage hole in a thickness direction provided at an end portion in the longitudinal direction of the base.
Fig. 8 is a front view of a modified example in which a slit, which is fixing means for fixing the distal end portion of the surgical claw, is added to the base.
Fig. 9 is a perspective view showing a state in which the base is deformed into a cylindrical shape, and shows a state in which the distal end of the surgical claw is inserted into the slit and fixed to the base.
10 is a front view of a modified example in which a through hole serving as fixing means for fixing the distal end portion of the surgical claw is added to the base body.
Fig. 11 is a perspective view showing a state in which the base is deformed into a cylindrical shape, and shows a state in which the distal end of the surgical claw is fixed to the base by a thread passed through the through-hole.
Fig. 12 shows a state in which a distal end portion of a surgical claw is formed with a through-hole and is passed through a through hole of a gas passage and a through hole of a surgical claw, and a distal end portion of the surgical claw is fixed to the base.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Next, embodiments of the present invention will be described in detail with reference to the accompanying drawings, but the present invention is not limited to the embodiments shown in the accompanying drawings, but includes all embodiments that satisfy the requirements described in the claims.

The small incision submucosal incision opening device 1 according to the embodiment of the present invention, which is shaped like a rectangle in a perspective view of Fig. 1, a front view of Fig. 2a and a bottom view of Fig. 2b, The incision in the incised body is kept open so as to secure the surgical field of view.

The can opener 1 is a thin plate of a tin material having a purity of 99.9% or more and includes an elongated rectangular base body 2 in an expanded state and has an end portion U in a long direction U in the form of a rectangular base body 2 And bending portions 3 and 4 bent in a loop shape around axes D and E parallel to the short direction V are formed on the front surface A of the base body 2 and convex portions 7 and 8 are formed on the surface A of the base body 2, 7, ...).

Tin has a crystal structure of tetragonal β-tin at room temperature and normal pressure, and is a soft silver-white metal. It does not react with oxygen because it is not attacked by oxygen because of the oxide film.

The purity of the tin forming the base body 2 is 99.9% or more, that is, the base body 2 contains 99.9 wt% or more of tin. Therefore, the base body 2 is particularly flexible and can be easily bent, for example, with a hand or a surgical instrument.

The outer shape of the base 2 is 1 to 5 cm in width W, 3 to 20 cm in length L and 0.5 to 2 mm in thickness T, The length L of the base body 2 is set to be 3 to 5 cm in the range of the width W of the base body 2 in the range of 1 to 5 cm in accordance with the size required for the use portion in order to keep the opening portion of the body open. The thickness T of the base body 2 is selected in the range of 0.5 to 2 mm in order to secure the required bending rigidity at the site of use.

The base 2 is made of a 3N tin ingot (purity 99.9% or more) or a 4N tin ingot (purity 99.99% or more), which is a high purity tin ingot having a very high ductility, And is formed into a plate having a required thickness by forging or rolling instead of casting, and then formed into a rectangular shape having a required width and length. By forming in this manner, the purity of the base body 2 becomes equal to the purity of the tin ingot, and thus the purity is 99.9% or more.

The projections 7 are formed on the surface A of the base body 2 by press working and at the same time the bending portions 3, 4).

As shown in the bottom view of FIG. 3A and the bottom view of the enlarged vertical section of the main part of FIG. 3B, in the shape in which the base 2 is extended in a rectangular shape, The tubular bodies 5 and 6 having the through holes 5A and 6A parallel to the short direction of the base 2 may be provided instead of the tubular bodies 3 and 4. [

The tubular bodies 5 and 6 are separate from the base body 2 and are made of a synthetic resin such as PA (polyamide) resin, PET (polyethylene terephthalate) resin or PEEK (polyetheretherketone) resin.

Since the base 2 is a thin plate of a tin agent having a purity of 99.9% or more and is elongated and elongated in the expanded state, the base 2 for surgery under the small incision can be formed into a rectangular shape The gas 2 can be inserted into the body through a small incision in the chest or abdomen in a compact form and can be easily carried to the open mouth of the body incised during surgery .

In addition, since the base body 2 is a tin agent having a purity of 99.9% or more, the base body 2 can easily be bent and deformed to a required shape by using the above-described surgical instrument. For example, .

The operation of deforming the base body 2 into a desired shape can be performed more easily by holding the appropriate portions of the bending portions 3 and 4 with the end effector of the jaw or the like of the surgical instrument and operating the surgical instrument with the above- .

3 (a) and 3 (b), the end effector of the surgical instrument grasps the proper position of the tubular bodies 5 and 6, .

As shown in Fig. 4, the base 2 of the can opener 1 is bent and deformed into a necessary shape, and the can is held on a can opener in the body, so that the can opener can be kept open so as to secure an operation field.

In addition, since the base 2 of the canker 1 can be easily deformed, it is possible to easily secure an operation field to be considered by the practitioner (of the doctors) The change can be made flexibly.

Further, by operating the can opener 1 by the operator, the burden of the operation assistant such as the correction by the pull type hook is eliminated, and the operation cost can be reduced by the reduction of the labor cost.

Since the base 2 of the can opener 1 is made of a tin agent having a purity of 99.9% or more, it can be easily deformed into a rectangular shape or a small aggregate shape by using the above- So that it can be easily taken out from the small incision window to the outside of the body.

In the use state as shown in Fig. 4, there are convex portions 7, 7, ... on the cylindrical surface C, which is the surface facing the opening portion of the can opener 1, and these serve as anti-slip convex portions. In other words, since the opening device 1 is difficult to fall from the opening portion of the body by the anti-slip convex portion, the opening portion suddenly moves to suddenly come into contact with the non-affected portion, It is possible to efficiently perform the operation while keeping the surgical field clear.

The non-slidable convex portions are convex portions 8, 8, ... provided in three rows in the width direction as shown in the perspective view of Fig. 5A, convex portions 9, 9, ... as shown in a perspective view of Fig. And is not limited to the form of this embodiment.

7A, 7B, 7B, ... may be provided on both surfaces A, B of the base 2 as shown in the longitudinal section bottom view of Fig. 6, , It is possible not to distinguish between the two surfaces A and B but to face the opening portion.

Such double-side processing can be easily performed by double-side embossing or the like in which a material is passed between a pair of embossing rolls having irregularities on the surface and pressure-contacted to the rolls.

The convex portions 7 shown in the front view of Fig. 2A and the perspective view of Fig. 4 are provided spirally on the cylindrical surface C of Fig. 4 in which the base body 2 is deformed into a cylindrical shape.

In the case where the spiral convex portion formed on the cylindrical surface C is a right-handed screw, the spiral convex portion formed on the cylindrical surface C is left-handed when it is rotated clockwise, , It moves in the counterclockwise direction and moves backward in the clockwise direction.

Therefore, it is easy to move the can opener 1 in the entering direction or the retracting direction with respect to the can opener in the body.

The "convex portion" of the present invention may be a convex portion (each convex portion is spaced apart) projected independently from the surface A (cylindrical surface C) and the surface B like the present embodiment, And may be a continuous linear shape (convex) or the like.

The can opener 1 shown in the perspective view of Fig. 7 has passage holes 10A and 10B in the thickness direction at an end portion in the longitudinal direction U of the base body 2.

Therefore, the thread is passed through the through-hole 10A or 10B provided at the end of the base 2 in the longitudinal direction, and one end is fixed, and the other end of the thread is inserted into the body It is possible to reliably prevent the opening of the canker 1 from being lost in the body by drawing it out of the incision through the body.

In addition, when the base 2 is likely to be twisted in the opening portion of the body, the base 2 can be fixed by fixing it to a nearby tissue through the passage hole 10A or 10B.

The opening device 1 shown in the front view of Fig. 8 has slits 11 and 11 elongated in a long direction U at the central portion of the longitudinal direction U of the base 2.

The distal end portion 13 of the surgical claw G is fixed to the base body 2 by passing the distal end portion 13 of the surgical claw G through the slits 11 and 11 as shown in the perspective view of Fig. can do.

The slits 11 and 11 function as fixing means F for fixing the distal end portion 13 of the surgical claw G to the base body 2. [

9, the distal end portion 13 of the surgical claw G may be threaded to the base body 2. In this case, In this case, the thread also functions as the fixing means (F).

The opening device 1 shown in the front view of Fig. 10 has passage holes 12, 12, ... in the thickness direction at a central portion in the longitudinal direction U of the base 2.

The thread 14 is passed through the through-holes 12, 12, ... in Fig. 10 so as to bind the distal end portion 13 of the surgical claw G with the thread 14, as shown in the perspective view of Fig. 11 The distal end portion 13 of the surgical claw G can be fixed to the base body 2. [

12 or the like as shown in the perspective view of Fig. 12, the thickness of the thread 14 formed on the distal end portion 13 of the surgical claw G, The distal end portion 13 of the surgical claw G can be fixed to the base body 2 by passing the thread 14 through the through holes 13A,

The through holes 12 and 12 and the seal 14 function as fixing means F for fixing the distal end portion 13 of the surgical claw G to the base body 2. [

The distal end portion 13 of the surgical claw G is fixed to the base 2 by the fixing means F as described above and the incising device 1 is held with the surgical claw G while the incision The can opener 1 can be easily and reliably carried to the can opener of the body and the can opener 1 can be easily and reliably taken out of the cannula after the operation.

In addition, since the base 2 of the can opener 1 is fixed to the distal end portion 13 of the surgical claw G, it is possible to reliably prevent the canker 1 from being lost in the body.

1: Starter
2: gas
3, 4:
5, 6: Cylindrical body
5A, 6A: through hole
7, 7A, 7B, 8, 9:
10A, 10B: Through hole
11: slit
12: Through hole
13:
13A: Through hole
14: Room
A, B: surface
C: Cylindrical surface
D, E: axis parallel to the short direction of the rectangle
F: Fixing means
G: Surgical hook
L: Length
T: Thickness
U: Long direction
V: Short direction
W: Width

Claims (8)

In the operation under the small incision, the incision in the incision is maintained in the open state to secure the surgical field.
A thin plate of a tin agent having a purity of 99.9% or more, and an elongated oblong substrate in an unfolded state,
Lt; / RTI >
The gas is inserted into the body from a small incision window in a form in which the gas is expanded in a rectangular shape or in a form in which the gas is compacted into small pieces,
Wherein the surgical instrument is carried by a surgical instrument used for surgery under the condition of small incision, and the gas is bent and deformed into a necessary shape by the surgical instrument to be used in a state where it is placed on the canine window. Dog breeder. In the operation under the small incision, the incision in the incision is maintained in the open state to secure the surgical field.
A thin plate of a tin agent having a purity of 99.9% or more, and an elongated oblong gas
Lt; / RTI >
A fixing means for fixing the distal end of the surgical claw to the base
And,
Wherein the fixing means is inserted into the body from the small incision window in a state in which the base body is formed into a rectangular shape while the distal end portion of the surgical claw is fixed to the base body with the surgical claws,
Wherein the surgical instrument is carried to the opening of the body by the surgical hook and is bent and deformed into a necessary shape by a surgical instrument used for a small incision undergrowth operation so as to be used in a state of being placed on the opening window, Dragon dogs. The gasket according to any one of claims 1 to 3, wherein the base has a rectangular shape, the outer shape of the base is 1 to 5 cm in width, 3 to 20 cm in length, and 0.5 to 2 mm in thickness. Surgical open canine. 4. The bending machine according to any one of claims 1 to 3, further comprising a bending portion bent in a loop shape around an axis parallel to a short direction of the base body at an end portion in the longitudinal direction of the base body in the form of extending the base body in a rectangular shape Wherein the catheter is inserted into the catheter. The gasket according to any one of claims 1 to 3, further comprising a tubular body having a through-hole parallel to a short direction of the base at an end portion in the longitudinal direction of the base in the form of extending the base in a rectangular shape It is a small incision scoring-down dog cannon. 6. The opener according to any one of claims 1 to 5, further comprising a non-slip convex portion on one or both sides of both surfaces of the base body. 7. The opener according to any one of claims 1 to 6, wherein a spiral convex portion is provided on a cylindrical surface obtained by deforming the base body into a cylindrical shape. The method according to any one of claims 1 to 7, wherein the gas is formed into a rectangular shape and a passage hole in a thickness direction is provided at an end portion in a longitudinal direction of the gas, Surgical opener.

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